The sickle cell program at St. Luke's-Roosevelt Hospital Center has been in existence for almost 25 years. The Program offers comprehensive medical care, i.e. total preventative and maintenance services, as well as diagnosis and management of acute chronic manifestations/complications of the disease and, when needed, referral for other medical problems as they arise. Nursing services, genetic counseling, social case work and counseling services are integral parts of the program. Support services are offered via group and individual approaches. All the diagnostic and therapeutic services available in a tertiary care facility are available to the patient. We plan to continue all of these efforts. For the next five years our specific objectives are to: I. Ensure that all patients have the availability of an appropriate medical 'home' by working with the state of New York, individual patients, and HMOs and other managed care organizations to guarantee experienced medical care for sickle cell patients. II. Expand our educational programs, via the media, and personal contact, with major emphasis on the Latino community, and managed care organizations, particularly those which will be accepting Medicaid patients. III. Establish and/or expand existing patient support groups. Program outreach to managed care organizations so that they recognize the importance of providing consultation services around those psychosocial issues which frequently and particularly concern sickle cell patients. IV. Concentrate initially on the following three new collaborative proposals: the pain program at Harlem Hospital, the Butyrate proposal at Mt. Sinai, and the HMO proposal at the University of North Carolina. In addition we will, of course continue with all current collaborative efforts.